MEDICARE: SENIOR STAR CORP. DAY HAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033590070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR STAR CORP. DAY HAB

Provider Business Mailing Address
First Line	:	1676 N OLDEN AVE
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08638-3209
Country	:	US
Telephone Number	:	609-434-0041
Fax Number	:	609-434-0043

Provider Business Practice Location Address
First Line	:	1676 N OLDEN AVE
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08638-3209
Country	:	US
Telephone Number	:	609-434-0041
Fax Number	:	609-434-0043

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JULIA KIPNIS
Credential	:
Telephone Number	:	609-434-0041

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	08/24/2015

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